,NR 546 Advanced Pharmacology and NR 548
Psychiatric Assessment
Prefrontal Cortex Symptoms of MDD - <<ANSWER>>Concentration
Mental Fatigue
Mood
PFC & Amygdala Symptoms of MDD - <<ANSWER>>Guilt
Suicidality
Worthlessness
Striatum Symptoms of MDD - <<ANSWER>>Physical fatigue
Nucleus Accumbens Symptoms of MDD - <<ANSWER>>Pleasure interests
Hypothalamus Symptoms of MDD - <<ANSWER>>Sleep
Appetite
Thalamus & Hypothalamus Symptoms of Mania - <<ANSWER>>Decreased
sleep/arousal
Striatum Symptoms of Mania - <<ANSWER>>Motor/agitation
Prefrontal cortex (PFC) Symptoms of Mania - <<ANSWER>>Risk-taking
Talkative/pressured speech
Nucleus Accumbens & PFC Symptoms of Mania - <<ANSWER>>Racing
thoughts, grandiosity
,PFC & Amygdala Symptoms of Mania - <<ANSWER>>Mood
Medication Management - <<ANSWER>>SSRI-Selective Serotonin Reuptake
Inhibitors
*Inhibit 5 HT reuptake
SNRI-Serotonin Norepinephrine Reuptake Inhibitors
*inhibit 5-HT reuptake
*inhibit NE reuptake (increase energy, focus)
*increase DA in prefrontal cortex (increase cognition)
NDRI-Norepinephrine Dopamine Reuptake inhibitors
*inhibit DA reuptake (increase alertness, motivation)
*inhibit NE reuptake (increase energy)
SARI-Serotonin Antagonist Reuptake Inhibitors
Selective Serotonin Reuptake Inhibitors (SSRIs): Most adverse effects will
subside after 4-5 days once the body adjusts to increased serotonin levels. -
<<ANSWER>>diarrhea
headache
weight gain
sexual side effects
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs): Medications should
not be abruptly stopped to avoid discontinuation symptoms. NE effects of the
medication may increase anxiety in some clients. Report worsening anxiety to
the provider. - <<ANSWER>>elevated blood pressure
anxiety
insomnia
constipation
Norepinephrine Dopamine Reuptake Inhibitors (NDRI): Take medication in the
morning. Stop taking medication if seizures occur. Stop taking medication if
anxiety is noted. - <<ANSWER>>agitation
headache
dry mouth
constipation
weight loss
, escitalopram (Lexapro) SSRI - <<ANSWER>>no known drug interactions
best tolerated SSRI
27-32 hour half-life good for forgetful prone clients
least CYP reactions
Substrate for 3A4
citalopram (Celexa) SSRI - <<ANSWER>>mild antihistamine effects; Half-Life:
23-45 hours
Weak Inhibitor of 2D6
fluoxetine (Prozac) SSRI - <<ANSWER>>longest half-life
Use caution in patients with comorbid anxiety due to risk for activation and
panic attacks
Half-Life: 2-3 days parent, 2 week metabolite
Inhibits 2D6 and 3A4
paroxetine (Paxil) SSRI - <<ANSWER>>also treats social anxiety and insomnia
associated with weight gain
will experience withdrawal with missed dose or abrupt stop
Half-Life: 24 hours
Inhibits 2D6
fluvoxamine (Luvox) SSRI - <<ANSWER>>treats anxious depression smokers
require an increased dose
Half-Life: 9-28 hours
Inhibits 3A4, 2C9, 1A2
sertraline (Zoloft) SSRI - <<ANSWER>>also treats social anxiety and
hypersomnolence
Half-Life: 22-36 hour parent; 62-104 hour metabolite
Inhibits 2D6 and 3A4 weakly at low doses
venlafaxine (Effexor) - <<ANSWER>>treats both depression and anxiety
disorders, ensure trial of higher dose before switching to a different
medication
Half-life: Parent drug 3-7 hour; metabolite has 9-13 hour
Psychiatric Assessment
Prefrontal Cortex Symptoms of MDD - <<ANSWER>>Concentration
Mental Fatigue
Mood
PFC & Amygdala Symptoms of MDD - <<ANSWER>>Guilt
Suicidality
Worthlessness
Striatum Symptoms of MDD - <<ANSWER>>Physical fatigue
Nucleus Accumbens Symptoms of MDD - <<ANSWER>>Pleasure interests
Hypothalamus Symptoms of MDD - <<ANSWER>>Sleep
Appetite
Thalamus & Hypothalamus Symptoms of Mania - <<ANSWER>>Decreased
sleep/arousal
Striatum Symptoms of Mania - <<ANSWER>>Motor/agitation
Prefrontal cortex (PFC) Symptoms of Mania - <<ANSWER>>Risk-taking
Talkative/pressured speech
Nucleus Accumbens & PFC Symptoms of Mania - <<ANSWER>>Racing
thoughts, grandiosity
,PFC & Amygdala Symptoms of Mania - <<ANSWER>>Mood
Medication Management - <<ANSWER>>SSRI-Selective Serotonin Reuptake
Inhibitors
*Inhibit 5 HT reuptake
SNRI-Serotonin Norepinephrine Reuptake Inhibitors
*inhibit 5-HT reuptake
*inhibit NE reuptake (increase energy, focus)
*increase DA in prefrontal cortex (increase cognition)
NDRI-Norepinephrine Dopamine Reuptake inhibitors
*inhibit DA reuptake (increase alertness, motivation)
*inhibit NE reuptake (increase energy)
SARI-Serotonin Antagonist Reuptake Inhibitors
Selective Serotonin Reuptake Inhibitors (SSRIs): Most adverse effects will
subside after 4-5 days once the body adjusts to increased serotonin levels. -
<<ANSWER>>diarrhea
headache
weight gain
sexual side effects
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs): Medications should
not be abruptly stopped to avoid discontinuation symptoms. NE effects of the
medication may increase anxiety in some clients. Report worsening anxiety to
the provider. - <<ANSWER>>elevated blood pressure
anxiety
insomnia
constipation
Norepinephrine Dopamine Reuptake Inhibitors (NDRI): Take medication in the
morning. Stop taking medication if seizures occur. Stop taking medication if
anxiety is noted. - <<ANSWER>>agitation
headache
dry mouth
constipation
weight loss
, escitalopram (Lexapro) SSRI - <<ANSWER>>no known drug interactions
best tolerated SSRI
27-32 hour half-life good for forgetful prone clients
least CYP reactions
Substrate for 3A4
citalopram (Celexa) SSRI - <<ANSWER>>mild antihistamine effects; Half-Life:
23-45 hours
Weak Inhibitor of 2D6
fluoxetine (Prozac) SSRI - <<ANSWER>>longest half-life
Use caution in patients with comorbid anxiety due to risk for activation and
panic attacks
Half-Life: 2-3 days parent, 2 week metabolite
Inhibits 2D6 and 3A4
paroxetine (Paxil) SSRI - <<ANSWER>>also treats social anxiety and insomnia
associated with weight gain
will experience withdrawal with missed dose or abrupt stop
Half-Life: 24 hours
Inhibits 2D6
fluvoxamine (Luvox) SSRI - <<ANSWER>>treats anxious depression smokers
require an increased dose
Half-Life: 9-28 hours
Inhibits 3A4, 2C9, 1A2
sertraline (Zoloft) SSRI - <<ANSWER>>also treats social anxiety and
hypersomnolence
Half-Life: 22-36 hour parent; 62-104 hour metabolite
Inhibits 2D6 and 3A4 weakly at low doses
venlafaxine (Effexor) - <<ANSWER>>treats both depression and anxiety
disorders, ensure trial of higher dose before switching to a different
medication
Half-life: Parent drug 3-7 hour; metabolite has 9-13 hour
